Spinal Fixation Surgery Research Articles

Effectiveness and cost-effectiveness of acute hospital-based spinal cord injuries services: systematic review.

To examine four key areas: (1) the effectiveness and cost-effectiveness of spinal fixation surgery, (2) the consequences of immediate versus delayed referral to a spinal injuries unit (SIU), (3) the number of people with a new spinal cord injury (SCI) who are discharged from hospital without ever being transferred to an SIU, and (4) the effectiveness and cost-effectiveness of steroids for people with SCI. Searches were carried out on several databases and also on the Internet. Specialist SCI and spinal injury related websites were searched, specifically the Spinal Injuries Association, the British Association of Spinal Cord Injury Specialists and the National Spinal Cord Injury Association. Three separate search strategies were devised to find studies relating to the four key areas. Two reviewers independently screened all study citations for inclusion. The lists of all retrieved studies were scanned for additional studies. Quality of studies was assessed and data were extracted by one reviewer then checked by the second. Data from included studies were summarised within each key area. For dichotomous data, relative risks were calculated with 95% confidence intervals. Pooled relative risks were calculated as appropriate. For continuous data, mean differences with 95% confidence intervals were calculated and, if data were pooled, weighted mean differences were calculated. Searches were carried out to identify economic evaluations, details of these together with a critical appraisal of quality are presented in structured tables. Quality was assessed using a checklist supplemented with additional comments on the adequacy of methodology where appropriate. For spinal fixation versus no fixation, 68 retrospective observational studies were found that suggested some benefits of fixation surgery. Only four studies were found on fixation surgery in SIUs compared with non-SIU hospitals and no significant differences were seen. All 28 studies concerning delayed referral to a SIU were retrospective observational studies. In most, study details were poorly reported and there was doubt over the comparability of groups at baseline and on confounding factors. Times of referral and transfer were not reported separately. Evidence suggested an effect in favour of the SIU group for neurological improvement. No relevant published studies of any design were found regarding how many people with a new SCI are discharged from hospital without ever being transferred to an SIU. Two systematic reviews were found that assessed the effectiveness of steroids. No studies were identified that considered both costs and the impact on patient outcomes of a given intervention. Although there was evidence to suggest some benefits of fixation surgery and also a benefit of immediate referral to SIUs compared with delayed or no referral, owing to the limitations of the data these should be interpreted with caution. Not enough data were found to assess whether surgery is more beneficial when carried out in SIUs and further research is required in this area. Well-designed prospective observational studies with appropriately matched controls are needed. High-dose methylprednisolone steroid therapy may be effective in promoting some degree of neurological recovery if given within 8 hours of injury. There is a need for more randomised controlled trials (RCTs) of pharmacological therapy for acute SCI. No published studies of any design were found to answer the question of how many people with acute SCI are discharged from hospital without ever being transferred to an SIU. Primary research involving audit of selected hospital records should be commissioned and published. The search strategy did not identify any full economic evaluations. Future research should include full economic evaluations, possibly alongside a large RCT, which fully consider the costs and consequences of implementing interventions.

Clinical evaluation of a system for precision enhancement in spine surgery

Most techniques in segmental spinal fixation surgery rely on the identification of predefined targets with the help of anatomical landmarks and on intraoperative use of image intensifiers. However, because there is no direct link between the image information, the accessible spinal anatomy, and the action of surgical instruments several potential problems and possible complications are still involved. A novel system for spinal surgery has been designed allowing for the real-time, intraoperative localization of surgical instruments in medical images. In practice this was achieved by combining image-guided stereotaxis with advanced optoelectronic position sensing techniques. Modules were developed for image data processing, surgical planning and simulation, and various intraoperative procedures. A detailed validation of the system was performed indicating an overall accuracy to be better than the slice distance of the spinal image used. In an in-vitro setting 20 pilot holes for pedicle screws were prepared in human cadaveric lumbar spines. An analysis in 77 histological cuts showed an ideal location in 70 and only minor cortex engagement in seven sections. In vivo the system has been successfully applied in three posterior low lumbar stabilizations with overall 15 transpedicular screws.

Segmental Spinal Instrumentation Using Short Closed Wire Loops

The Luque technique of segmental sublaminar instrumentation is now an established method of internal fixation in spinal surgery. The major difficulty encountered with the current technique is the danger of neurologic injury during the passage and handling of conventional wires, especially in extensive procedures. Great care is required to prevent inadvertent percussion of the wires already passed. The authors believe that by using short closed wire loops, these dangers have been minimized. Simple additional instrumentation has been devised to facilitate application of these loops. Apart from ease of application and handling, the short wire loops may offer a safer method of segmental sublaminar fixation.